1. Pectus Excavatum
Kamil Arif, R1

2. What is it? congenital chest wall deformity
characterized by concave depression of the sternum
MC chest wall deformity (1 in births)

3. Radiographic Features
Plain film
blurring of right heart border (PA or AP film)
increased density of the inferomedial lung zone
horizontal posterior ribs
vertical anterior ribs (heart shaped)
displacement of heart towards the left
obliteration of the descending aortic interface

4. Radiographs

5. Nuss Procedure
Concave stainless steel bar placed underneath the sternum
What to watch out for??

6. CT
The Haller index (maximal transverse diameter/narrowest AP length of chest) is used to assess severity of incursion of the sternum into the mediastinum. Normal Haller index is 2.5.
Significant pectus excavatum has an index greater than 3.25, representing the standard for determining candidacy for repair

7. Haller Index

8. Possible Future Interventions
The Magnetic Mini-Mover Procedure (3MP) is a novel minimally invasive method of correcting pectus excavatum developed at UCSF Pediatric Surgery. With this method the deformed costal cartilages are gradually reformed by a controlled gradual outward "pull" on the depressed breastbone. This is achieved with an outpatient surgical procedure and without the need for painful implanted chest wall struts. Two magnets, one implanted inside the chest and attached to the sternum and the second one outside the chest wall and attached to an external brace, are used together to create a magnetic force field which applies a controlled sustained pull. 

9. References
Radiopaedia
UCSF Pediatric surgery